2012 overall world AIDS stats: Good news
As more of the 34 million with HIV gain access to antiviral therapy, fewer are
dying of HIV infection. This is especially true in sub-Saharan Africa,
according to a recent UN report. The decreases in deaths show that providing
therapies to the developed world is working. Around 60 percent of the more than
thirty million with HIV worldwide are on treatment. World health organizations
such as UNAIDS have set a goal of significantly increasing that number by 2015.
That requires $5 billion more in funding, however. Considering the world
economic climate, that money may be hard to come by.
Landmark HTPN 052 study keeps on giving
Several studies now show that providing anitivirals for those with HIV could
significantly help end the HIV pandemic. That is because HIV infected people
who take antiviral drugs are far less infectious. This treatment-as-prevention
approach (also known as TasP) has been shown to reduce the HIV transmission by
up to 96%. That is, at least among people who are more frequently exposed to
HIV such as HIV negative spouses of those with the virus.
Of these studies, the ground-breaking treatment-as-prevention study, HPTN 052,
is showing that those who start treatment earlier are less likely to develop
HIV related infections than those starting later. Those who started treatment
when their CD4 immune cell counts were higher suffered fewer HIV related
infections than those who delayed treatment.
Another benefit to treatment-as-prevention is that it could save money as well
as lives. Published studies already reveal that providing HIV treatment - -
instead of allowing millions of people to get sick and die --- has positive
effects on AIDS ravaged national economies. An important cost/benefit study
presented at the International AIDS Conference (IAC 2012) showed that early
implementation of treatment-as-prevention on a massive scale (in India and
South Africa) would be more cost effective than delaying treatment access in
Study researcher Dr. Rochelle Walensky called TasP a triple trifecta:
HIV-infected patients remain healthy longer, their partners are protected from
the virus, and it is cost-effective. "Regardless of the country setting," she
added, "over the long-term, treatment as prevention offers excellent return on
Romneycare and a
Last year, a study by the Africa Centre for Health and Population Studies
revealed that treatment-as-prevention works on a community-wide scale. The
study, done in the South African province of KwaZulu-Natal, found that
transmission rates of the virus to others decreased as more HIV-infected
community members got on treatment.
Something similar seems to be happening in Massachusetts and it may be due to
the states mandatory health insurance program known as Romneycare. Since
Massachusetts implemented the program in 2006 the rate of new HIV infections
have been declining. That's probably because 98% of Bay State residents now
have health insurance so residents with HIV have access to care and treatment.
That means fewer infectious state residents to spread HIV.
Tragically, HIV infection rates are not going down in states where people can’t
readily get health insurance. To make things worse, some states are fighting
Medicaid expansion of Obamacare. That expansion would provide health care to
millions of people including many with HIV.
Many of these states (in the south in particular) are also where the epidemic
is exploding. Fewer people with insurance means fewer on HIV treatment. That
also means more people will be likely to infect others and so fuel the spread
of the virus.
In Massachusetts, however, universal health coverage is not only lowering HIV
transmission rates, it's saving the state money — a lot of money in fact.
Studies show that for every new Massachusetts infection that is prevented, the
government saves about $500,000!
Save lives and money. Now that’s a great deal. So take heed America.
The Continuum of
Care: Slipping through the cracks
The CDC estimates that 1.1 million people in the United States have HIV.
However, about one in five are not aware of it, and they may be
disproportionately responsible for the 50,000 new HIV infections that occur in
the U.S. each year. Alarming data which the CDC recently updated at IAC 2012 showed
that only a quarter of all Americans with HIV have their virus under control.
So just in the U.S., there is a lot of work still to be done to stop the virus.
infamous graph: Failure in the continuum of care
One increasingly important way of getting people into care is to regularly
screen for HIV. The new OraQuick In-Home HIV Test should make that ever more
possible. The in-home test provides results in around 30 minutes. As part of an
aggressive public health testing campaign, HIV epicenters, like Washington
D.C., are offering new quickie HIV tests in hair salons, barber shops, even the
DMV as people wait to take their drivers test. In highly infected neighborhoods
of Philadelphia, faith leaders are offering testing door to door. In L.A. the
AIDS Healthcare Foundation, with celebrities in tow, has been hitting the clubs
to offer a next-generation HIV test that provides results in minutes. These new
and aggressive outreach screening efforts get people tested and if need be,
And there is good reason for doing so. More and more studies show that HIV does
considerable damage during the early, so-called, asymptomatic stage of
infection. Earlier treatment can help prevent the damage related to HIV infection.
•Chronic hyper-Inflammation of the immune system (inflammation that also has
been tied to cancer and heart disease).
•Physical degradation of the lymph system and irreversible damage and
reductions in vital immune cells (cd4, cd8, dendrites).
•Neurological damage, especially caused by certain strains of HIV.
•HIV seeding of reservoirs throughout body. Such seeding may diminish the
likelihood of being cured of HIV one day.
•And, oh yes. Earlier treatment prolongs survival.
With early treatment making more sense, the U.S. Department of Health and Human
Services and International AIDS Society-USA recently updated their HIV
treatment guidelines. They now recommend that everyone with HIV, regardless of
CD4 count, should be offered treatment. This reflects a worldwide shift toward
earlier treatment intervention for everyone who has HIV. A big reason for this
is the potential benefit that treatment-as-prevention could have in containing
and possibly even ending the worldwide epidemic.
High Risk: The
biology of MSM transmission
Thanks to treatments advances, HIV transmission rates and deaths are declining
throughout the world. However, among men who have sex with men (MSM) the
epidemic rages on. In the U.S., new infection rates among MSM have been
increasing by around 8% per year since 2001. One reason, according to a study
in The Lancet,
is that the risk of HIV transmission through anal sex is 18-times greater than
vaginal intercourse. The study adds that if casual MSM partners only had sex within
long-term partnerships, HIV infections would decrease by 29-51%. The data also
raises an important question. Will TasP, with its 96% level of protection, work
as well for MSM as it did for heterosexual couples. Only 3% in the famed HTPN
052 study were MSM.
contributing to HIV transmission is acute infection. That period of just days
or a little longer after someone is exposed to HIV. During acute infection HIV
viral load levels explode. Sometimes flu-like symptoms also occur. During this
period people can be highly infectious, yet most people don't realize they have
contracted HIV and so they continue to take risks. So even if you have tested
negative recently but are sexually active, don't let your guard down and assume
you are not HIV infected. Always play like you (and your partner) have the
and men at risk
Data presented by Dr. Damien Tully at the
AIDS Vaccine Conference 2012 held in Boston showed that many MSM
may be infected with widely diverse strains of HIV. The study, which is still
ongoing, examined the virus of 22 MSM who had just become infected. About half
of those in the study had several variations of the virus. This is a concern
because viral diversity can speed HIV disease progression. The findings also
mean that it could be more of a challenge to discover an effective vaccine that
will work among MSM.
Dr. Tully's study also revealed another problem: sexual ecology, or the regular
sexual partnering within a certain group. Doing so can increase the risk of
contracting any illnesses or infections within that group. Many of the men in
Dr. Tully's study, all whom are Boston based, were shown to be infected with
the same, closely related strains of HIV. A study among African American MSM a
few years back found the men believed they were less at risk of HIV exposure
when partnering with other black MSM. This despite the fact that Black MSM have
high rates of HIV. The takeaway? HIV can sometimes be "all in the family". So
be wary of those you think you know. Don't let your guard down in the bedroom.
HIV and Black MSM
According to other Lancet
data, black MSM around the world are much more likely to have HIV. The
disparity is especially high in the USA and UK. Also according to the Lancet, black MSM
in the U.S. now make up nearly one in six of all people with HIV. At IAC 2012, Dr.
Karen Oster presented data on the black MSM "Brothers" study. It found that
over just one year, new HIV infections among these men increased by 2.3%. Among
those under the age of 30 the infection rate was an alarming 6%! The latter
strongly suggests that if the trend continues, by the time they are in their
40’s, most urban black MSM will have HIV.
Dr. Greg Millett of the CDC told IAC
2012 attendees that the reason for high black MSM infections is not
because these men are having more at risk sex than their white counterparts. He
said studies show that generally these men are more sexually cautious and less
likely to have substance abuse issues than white MSM. Recent CDC data also
shows that risky behavior among all black teens has declined significantly.
Instead, care access problems and sexual ecology are driving the black MSM
epidemic, according to Dr. Millet. New infections are coming from repeated
partnering within a highly infected community. Again, the takeaway is to be
aware of the risk of exposure within these high prevalence "pools" and not just
minimize risk during sex.